外周血中性粒细胞与淋巴细胞比值在重症COVID-19中的应用价值

目的 探讨外周血中性粒细胞与淋巴细胞比值(NLR)在重症新型冠状病毒肺炎(COVID-19)中的应用价值.方法 回顾性分析该院收治的55例COVID-19患者的临床资料.根据《新型冠状病毒感染的肺炎诊疗方案(试行第五版)》的临床分型标准,将重型和危重型患者纳入重症组(35例),轻型和普通型患者纳入非重症组(20例).比...     

武汉地区部分综合性医院康复医学科新冠肺炎感染患者临床特征的回顾性分析

目的:回顾性分析武汉地区部分综合性医院康复医学科新冠肺炎感染患者的临床特征,并探讨其受SARS-CoV-2感染的可能危险因素。方法:收集了2020年1月10日～2020年2月17日期间武汉地区10家综合性三级医院康复医学科确诊的18例住院患者的临床资料,分析其新冠肺炎的发病率、临床诊断、合并症、并发症等临床特征。结果:在653名康复医学科住院患者中共计18例感染SARS-CoV-2,感染率为2.76%,RR为7.45(95%CI,4.27-13.01)。18例感染者的年龄中位数为66(IQR,55.50-70.25)岁;其中13例诊断为脑损伤系统疾病,5例为肌骨系统疾病。18例患者中感染SARS-CoV-2前并发气管切开、意识障碍、肺部感染和吞咽障碍者的病亡率分别为50.00%、40.00%、33.33%和25.00%。主要的合并症包括高血压病、冠心病、糖尿病和陈旧性脑梗死,合并糖尿病、陈旧性脑梗死、高血压病和冠心病的感染者的病亡率分别为75.00%、50.00%、36.36%和20.00%。病亡患者的并发症为(1.80±1.64)项,合并症为(2.00±1.22)项;非病亡患者的并发...     

中性粒细胞/淋巴细胞比值与新型冠状病毒肺炎短期不良预后的相关性

目的 探讨中性粒细胞/淋巴细胞比值(NLR)对新型冠状病毒肺炎(COVID-19)短期不良预后的预测价值.方法 选取2020年1月28日—2月20日华中科技大学同济医学院附属同济医院收治的302例COVID-19患者作为COVID-19组,以2020年1月7日57名健康体检者作为对照组.COVID-19患者根据入院时临...     

细胞因子及炎症指标在新型冠状病毒肺炎患者预后评估中的价值

摘要：目的?探讨细胞因子及炎症指标在新型冠状病毒肺炎(COVID-19)患者预后评估中的临床价值。方法?采用回顾性分析方法。选取2020年1月19日至2020年2月26日序贯入住华中科技大学同济医学院附属同济医院的317例COVID-19患者为研究对象，记录入院24 h内首次细胞因子白细胞介素1受体(IL-1β)、白细胞介素2(IL-2R)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)及炎症指标C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)、铁蛋白(FRT)、白细胞绝对值(WBC)、中性粒细胞绝对值(NEUT#)、淋巴细胞绝对值(LYM#)、中性粒细胞绝对值与淋巴细胞绝对值比值(NLR)、临床分型、基础疾病等资料，并观察28 d生存或死亡事件。根据28 d生存或死亡事件分为生存组与死亡组，根据入院时临床分型分为普通型组、重型组与危重型组，比较分析各组细胞因子及炎症指标的差异；用ROC曲线分析以上细胞因子及炎症指标对COVID-19患者28 d死亡事件的预测价值。结果?死亡组较生存组相比，IL-2R、IL-6、IL-8、IL-10、TNF-α、PCT、CRP、WBC、NEUT#、NLR显著升高，LYM#显著降低，差异均有统计学意义(P<0.001)；随入院时临床分型(普通型组、重型组、危重型组)严重程度增加，IL-6、IL-8、IL-10、PCT、CRP、WBC、NEUT#、NLR亦随之显著升高，LYM#显著降低，两两比较差异均有统计学意义(P<0.05)；ROC曲线分析显示，IL-6、IL-8、PCT、CRP、FRT、WBC、NEUT#、LYM#、NLR有较好的预测价值，曲线下面积(AUC)>0.7，而IL-1β、IL-2R、IL-10、TNF-α及ESR则有一般或较低的预测价值(AUC<0.7)。结论?细胞因子IL-6、IL-8及炎症指标PCT、CRP、FRT、WBC、NEUT#、LYM#、NLR在COVID-19患者临床分型及28 d死亡事件中均具有良好的预测价值，以上细胞因子及炎症指标的异常往往预示不良预后。     

NLR与CRP在预测新型冠状病毒肺炎中的临床价值分析

目的探讨中性粒细胞与淋巴细胞比率(NLR)和C反应蛋白(CRP)在新型冠状病毒肺炎(COVID-19)预测中的应用价值。方法收集2020年1-2月在福建医科大学附属南平第一医院收治的20例COVID-19确诊患者作为COVID-19组,另选取同期在该院确诊的普通流感肺炎患者50例作为普通流感组以及参加健康体检的人员50例作为健康体检组。研究对象均进行一般情况调查,检测血液常规、凝血功能、生化常规指标和CRP等,计算NLR。采用受试者工作特征曲线(ROC曲线)分析NLR与CRP对COVID-19的预测效能。结果COVID-19组NLR、CRP较普通流感组和健康体检组显著增高(P<0.05),淋巴细胞(LYM)则明显降低(P<0.05);COVID-19患者治愈后的NLR、CRP、乳酸脱氢酶(LDH)均出现明显降低(P<0.05);ROC曲线分析显示:NLR和CRP具有较好的诊断效能。结论NLR和CRP具有较高的COVID-19诊断和治疗的监测价值。     

COVID-19重症化早期实验室预警的研究

目的探讨早期实验室指标在新型冠状病毒肺炎(COVID-19)病情严重度判断中的作用。方法回顾性分析85例COVID-19患者入院时外周血各项实验室检查结果,包括血常规、肝功能、肾功能、凝血功能、白介素-6(IL-6)、铁蛋白、C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、肌红蛋白、肌钙蛋白、淀粉样蛋白A,并对普通型和重症型患者各项数据进行分析比较。结果重症型COVID-19患者白细胞(WBC)计数、中性粒细胞绝对数(NEUT#)、中性粒细胞/淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、CRP、D-二聚体(DD)、铁蛋白和肌酐较普通型患者明显升高(P0.05)。早期WBC计数、NEUT#、NLR、LDH、肌红蛋白、CRP、铁蛋白升高是COVID-19患者重症化风险预测指标。NLR作为独立风险因子,临界值为5.61时,诊断重症化的敏感性为68.75%,特异性为78.38%。结论 COVID-19患者早期WBC计数、NEUT#、NLR、LDH、肌红蛋白、CRP和铁蛋白水平明显升高,提示存在重症化风险,其中NLR是COVID-19重症化的独立预警指标。     

不同类型新冠肺炎患者呼吸道护理体会

目的 调查新型冠状病毒感染肺炎(COVID-19)的相关临床资料及呼吸支持情况,为临床一线护理工作提供参考.方法 回顾性分析了2020年2月1日—3月15日在本院隔离病区住院治疗的57例COVID-19患者的相关临床资料,将57例患者分为普通型组(n=27)及重型和危重型组(n=30).分析两组患者的病情轻重程度,并比...     

新型冠状病毒肺炎输血患者的临床分析81例

目的 回顾性分析2020年2～3月武汉同济医院光谷院区新型冠状病毒肺炎患者的输血情况,总结输血病人的临床特点和用血情况.方法 1)回顾分析81例输血患者各血液成分的使用情况.2)利用倾向得分匹配(propensity score matching,PSM,匹配项为新冠临床分型)对输血和未输血患者按1∶2的比例进行匹配,...     

新型冠状病毒肺炎患者血液NLR，DD和 CRP水平联合检测对死亡风险的评估研究

目的 探讨中性粒细胞 /淋巴细胞比值（ NLR）、D-二聚体（ DD）、C反应蛋白（ CRP）水平联合检测评估新型冠状病毒肺炎（ COVID-19）患者的死亡风险。方法 2020年 1月 28日～ 3月 5日在武汉第三医院救治的 COVID-19患者 146例,其中生存组 105例（普通型组 46例、重型组 25例、危重型组 34例）,死亡组 41例,进行血细胞分析及 DD,CRP检测。采用 Mann-Whitney U检验、二元 Logistic回归、 Spearman相关分析、受试者工作特征（ROC）曲线等统计学方法,评估 NLR,DD,CRP单独及联合检测预测 COVID-19患者的死亡风险。结果 死亡组 NLR 13.18±23.31,DD 5.05±5.51 mg/L和 CRP102.84±120.99 mg/L明显高于生存组 (4.07±4.26,0.90±2.18 mg/ L ,34.33±92.40 mg/L),差异均有统计学意义（ z=-5.682,-4.466,-4.350,均 P<0.05）;二元 Logistic回归分析显示 NLR,DD,CRP均是 COVID-19感染的独立危险因素（ OR=1.054,1.056,1.225）,差异均有统计学意义（均 P<0.05）;相关分析显示 NLR与 DD（r=0.597）和 CRP（r=0.630）均呈正相关,差异均有统计学意义（均 P<0.05）; ROC曲线分析显示 NLR,DD,CRP联合检测的 AUC为 0.842,高于 NLR,DD和 CRP单独检测的 AUC（0.800,0.738和 0.732）。结论 NLR,DD和 CRP水平联合检测在预测 COVID-19患者的死亡风险中有较高的敏感度和特异度,弥补了单项检测的不足,在辅助诊断中有较高的价值。     

新冠肺炎疫情下社区居民焦虑现况及相关因素分析

目的 研究在新型冠状病毒肺炎疫情下社区居民的心理状况及相关因素,为社区心理护理提供依据,制定干预措施.方法 随机抽取200名重庆地区某社区居民进行调查,采用一般资料调查表、现况调查表、焦虑自评量表进行问卷调查,利用统计学进行相关因素分析.结果 社区居民SAS分值与中国常模相比,有显著差异.其中焦虑状态与工作状态、家庭成员、防护品不足、对新型冠状病毒肺炎态度和认知有关.结论 社区卫生机构人员应关注社区居民的心理状况,采取相应措施,以缓解疫情下社区居民的焦虑情绪.     

温州地区140例新型冠状病毒肺炎患者的临床特征分析

目的 探讨温州地区实验室确诊的新型冠状病毒肺炎患者的临床特点.方法 回顾性分析我院2020年1月至3月收治的140例新型冠状病毒肺炎患者的临床表现、实验室检查和影像学分析及治疗药物等,同时按病情严重程度分为非严重组和严重组,比较两组在临床特点、影像学和实验室主要指标的差异.结果 140例新型冠状病毒肺炎患者中男性75例...     

Impact of renin–angiotensin system inhibitors use on mortality in severe COVID-19 patients with hypertension: a retrospective observational study

ObjectiveAssociation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) use with coronavirus disease 2019 (COVID-19) remains controversial. We aimed to investigate the impact of ACEI/ARB use on all-cause mortality in severe COVID-19 patients with hypertension.MethodsWe enrolled 650 COVID-19 patients from Changsha and Wuhan city between 17 January 2020 and 8 March 2020. Demographic, clinical characteristics, and outcomes were collected. Multivariable analysis and propensity-score matching were performed to assess the impact of ACEI/ARB therapy on mortality.ResultsAmong the 650 patients, 126 who had severe COVID-19 concomitant with hypertension were analyzed. The average age was 66 years and 56 (44.4%) were men. There were 37 ACEI/ARB users and 21 in-hospital deaths (mortality rate, 16.7%). Male sex (odds ratio [OR], 5.13; 95% confidence interval [CI], 1.75 to 17.8), but not ACEI/ARB use (OR, 1.09; 95%CI, 0.31 to 3.43), was an independent risk factor for mortality in severe COVID-19 patients with hypertension. After propensity-score matching, 60 severe COVID-19 patients were included and no significant correlation between use of ACEI/ARB and mortality was observed.ConclusionsThere was no significant association of ACEI/ARB use with mortality in severe COVID-19 patients with hypertension. These findings support the continuation of ACEI/ARB therapy for such patients.     

12例新型冠状病毒肺炎患者临床特征分析

目的 分析新型冠状病毒肺炎（新冠肺炎）的临床和流行病学特征,为疫情防控提供参考。方法 收集2020-01-26至2020-04-05成都市中西医结合医院第二临床观察科确诊的12例新冠肺炎患者临床资料,对其基本信息、流行病学史、实验室检查、胸部CT等进行调查研究。结果 新冠肺炎患者男性多于女性,男女比为1.4∶1;病例以40岁以上中老年为主,普通型患者多于重型患者,重型与普通型比为1∶5;前期主要为本土病例,2月中旬之后主要为境外输入病例;本土病例中75%有武汉/湖北旅居史或新冠肺炎确诊患者密切接触史,潜伏期最短4天、最长11天;临床症状以发热、咳嗽、恶寒为主,白细胞未见明显升高,超敏 C反应蛋白升高,胸部CT以双肺磨玻璃样改变为主。重型患者白细胞、中性粒细胞、淋巴细胞、中性粒细胞百分比低于普通型患者,淋巴细胞百分比、超敏C 反应蛋白、胸部CT评分高于普通型患者。结论 新冠肺炎患者以男性为主,40岁以上为高发人群,发热是其最主要的临床症状,重型患者超敏C反应蛋白明显升高,胸部CT病灶明显。     

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning,China

BACKGROUNDCoronavirus disease 2019 (COVID-19) has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2. The severity, atypical clinical presentation, and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19. Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.AIMTo investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province, China.METHODSAdult patients (n = 65) with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29, 2020 in Liaoning Province, China. Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid. Patient demographic information and clinical data were collected from the medical records. Based on the severity of COVID-19, the patients were divided into nonsevere and severe groups. All patients were followed until March 20, 2020.RESULTSThe mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men, and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%) patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history of exposure. Twenty-nine (44.6%) patients had at least one comorbidity; hypertension and diabetes were the most common comorbidities. Compared with nonsevere patients, severe patients had significantly lower lymphocyte counts [median value 1.3 × 10⁹/L (interquartile range 0.9-1.95) vs 0.82 × 10⁹/L (0.44-1.08), P < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) vs 707 U/L (592-980), P < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) vs 52 mg/L (12.7-100.8), P < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) vs 23.5 d (19.6-30.3), P = 0.001]. The overall median viral shedding time was 19.5 d, and the longest was 53 d. Severe patients were more frequently treated with lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin, thymosin, and oxygen support. All patients were discharged following treatment in quarantine.CONCLUSIONOur findings may facilitate the identification of severe cases and inform clinical treatment and quarantine decisions regarding COVID-19.     

Hematological characteristics of COVID‐19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China

BackgroundA wave of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection has rapidly spread in Shanghai, China. Hematological abnormalities have been reported in coronavirus disease 2019 (COVID‐19) patients; however, the difference in hematological parameters between COVID‐19 patients with fever and patients who are febrile from other causes remains unexplored.MethodsThis retrospective cohort study enrolled 663 SARS‐CoV‐2 positive patients identified by RT‐PCR. Clinical parameters, including age, sex, and threshold cycle values of all COVID‐19 patients, and hematological parameters of COVID‐19 patients in the fever clinic were abstracted for analysis.ResultsOverall, 60.8% of COVID‐19 patients were male, and the median age was 45 years. Most of COVID‐19 patients were asymptomatic, while 25.8% of patients showed fever and 10.9% of patients had other emergencies. COVID‐19 patients with fever had significantly lower white blood cells (WBCs), neutrophils, lymphocytes, platelets and C‐reactive protein (CRP), and significantly higher monocyte‐to‐lymphocyte ratio (MLR), platelet‐to‐lymphocyte ratio (PLR), mean platelet volume (MPV), and mean platelet volume‐to‐platelet ratio (MPR) levels, compared with those in SARS‐CoV‐2 negative patients with fever from other causes (p < 0.05). Neutrophil‐to‐lymphocyte ratio (NLR), PLR, and systemic inflammatory index (SII) levels were significantly higher in COVID‐19 patients with emergencies (p < 0.05). WBCs showed the best performance with an area under the curve (0.756), followed by neutrophils (0.730) and lymphocytes (0.694) in the diagnosis of COVID‐19 in the fever clinic.ConclusionWBCs, neutrophils, lymphocytes, platelets, CRP and MLR, PLR, and MPR may be useful in early diagnosis of COVID‐19 in the fever clinic.     

Dose-response relationship between risk factors and incidence of COVID-19 in 325 hospitalized patients: A multicenter retrospective cohort study

BACKGROUNDThe epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients have been widely reported, but the assessment of dose-response relationships and risk factors for mortality and severe cases and clinical outcomes remain unclear.AIMTo determine the dose-response relationship between risk factors and incidence of COVID-19.METHODSIn this retrospective, multicenter cohort study, we included patients with confirmed COVID-19 infection who had been discharged or had died by February 6, 2020. We used multivariable logistic regression and Cox proportional hazard models to determine the dose-response relationship between risk factors and incidence of COVID-19.RESULTSIt clarified that increasing risk of in-hospital death were associated with older age (HR: 1.04, 95%CI: 1.01-1.09), higher lactate dehydrogenase [HR: 1.04, 95% confidence interval (CI): 1.01-1.10], C-reactive protein (HR: 1.10, 95%CI: 1.01-1.23), and procalcitonin (natural log-transformed HR: 1.88, 95%CI: 1.22-2.88), and D-dimer greater than 1 μg/mL at admission (natural log transformed HR: 1.63, 95%CI: 1.03-2.58) by multivariable regression. D-dimer and procalcitonin were logarithmically correlated with COVID-19 mortality risk, while there was a linear dose-response correlation between age, lactate dehydrogenase, D-dimer and procalcitonin, independent of established risk factors. CONCLUSIONHigher lactate dehydrogenase, D-dimer, and procalcitonin levels were independently associated with a dose-response increased risk of COVID-19 mortality.     

儿童COVID-19临床特征的Meta分析

目的 系统分析儿童新型冠状病毒肺炎(COVID-19)的临床特征.方法 采用计算机检索PubMed、Scopus、Web of Science、EMbase、中国知网、万方和维普数据库,收集与儿童COVID-19患者的临床特征相关的文献,检索时限为2020年1月1日至2020年5月8日.由2位研究员独立筛选文献、提取数...